Provider Demographics
NPI:1992126742
Name:GROSSI-ROSAL, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GROSSI-ROSAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 SW BARBUR BLVD STE 214B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5955
Mailing Address - Country:US
Mailing Address - Phone:503-997-3181
Mailing Address - Fax:503-922-2527
Practice Address - Street 1:10175 SW BARBUR BLVD STE 214B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5955
Practice Address - Country:US
Practice Address - Phone:503-997-3181
Practice Address - Fax:503-922-2527
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR064512251H1300X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman Factors
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics